Module 3 - Age Related Changes and Vulnerability Flashcards
Hair Changes with Age
Loss of melanin
alopecia may occur
Nail changes with age
thicken
brittle and flat
vertice or angular ridges
Oncholysis
Oncholysis
Nail lifting normal with age / fungal infection
Tactile Perception Changes with Age
Tactile sensation decreases due to skin and sensory neuron changes
Possible delayed pain transmission
Why is the origins of tactile perception changes difficult to determine?
it could either be d/t neuropathy of natural aging processes or an effect of disease
What occurs to pain transmission and perception with age?
possible delayed pain transmission
This does NOT mean patient has reduced pain perception, just slower
Integumentary conditions common with aging
Want for cosmetic surgeries
Rashes
Skin Cancer
Pruritis
Vascular Lesions
Pressure Injuries
Kyphosis/Hunchback from bending forward
Why do older people seem to get shorter?
their vertebral disks thin and they lose some height
Pruritis
itching
Elderly are at ___ risk for fracture
higher
Why is it important to do ROM with the elderly?
Their shortened tendons could lead to contracture so you want to prevent that
Why do vascular lesions occur in the elderly
poorer circulation
Why do pressure injuries occur in the elderly?
immobility
Musculoskeletal Structure changes with age?
Disks become thin and the person becomes shorter
Slight forward bent posture - kyphosis - hunchback
Bone changes with age?
Decrease in bone density
Higher risk for fractures
Joint, Tendon, and Ligament changes with age?
Cartilage changes
Tendons may shorten
Muscle changes with age?
atrophy of muscle mass tissues
Things to assess in the musculoskeletal system for the elderly
Feet - DM and vascular disease
Joint replacement
Osteoarthritis and osteoporosis
What are the two most common joint replacement needs in the elderly?
Hip and Knee joints
Osteoporosis
bone weakening and brittling
What are some reasons that Osteoporosis can occur?
Inadequate calcium absorption
Inactivity or Immobility
Reduction of anabolic sex hormones
Diet
Medications
What are the 3 general principles of caring for the elderly?
- manage pain!
- prevent injury!
- Promote Independence
Common Chronic Cardiovascular Disorders in the Elderly
HTN/Hypotension
CAD
HF
PVD (Peripheral Vascular Disease)
Cardiovascular Disease
What areas of the cardiovascular system are highly impacted with aging?
Valves
Conductivity (sclerotic potentially)
Blood vessels like arteries and veins
Atrial Fibrillation
rapid heartbeat commonly d/t bad blood flow
Heart Changes that occur with age?
Chronic Disorders
Atrial Fibrillation from fibrosis of SA node
Pulse pressure widens
Blood vessels of LE more likely to show s/s of cardiovascular changes r/t dependent position
S/S of Hypertension in the Elderly
Silent Killer!
Dull headache
confusion
epistaxis
Epistaxis
Nosebleed
What conditions can occur due to chronic HTN in the elderly?
CHD
A Fib
HF
MI
Stroke
Treatments for HTN
Medication Management
Rest
Diet
Why is diet so hard to work with in the elderly?
they will not want to change the diet they have eaten their whole life
When treating HTN it is important to keep what in mind?
Do not overtreat as it could cause hypotension, syncope or dizziness
S/S of CAD in the elderly
Mild Pain in the back, abdomen, shoulders, or arms
N/V or indigestion (nausea and vomiting)
HR > 80
Fatigue
Dizziness
Syncope or Confusion
Irritability
What is a big issue occurring with CAD in the elderly?
It is often misdiagnosed leading to a delay in treatment which could ultimately lead to death
Treatment for CAD
medications
physical and functional activity limitations - they need lots of rest as they are very unhealthy
Energy conservation -rest is needed
S/S of Heart Failure in the Elderly
General malaise
Dyspnea
Chronic Cough
Insomnia
Weight Loss
Nocturnal
Syncope
Delirium
Falls
Decreased Functional Ability
Ankle Edema (this is a major one) or Weeping Edema
What does Heart failure eventually lead to for the elderly?
Decline in physical functioning
Diminished cognition
Delirium
Alterations in skin breakdown (d/t weeping edema)
Treatment for Heart Failure
Medications
Oxygen
Comfort Measures (major one since there is not a lot that can be done)
S/S Of Peripheral Vascular Disease
Discoloration
Speckled (Hemosiderin) Edema
Ulcerations
Pain
Ulcers
DVT
Edema
Hemosiderin Deposits
Decreased Circulation
Poor Nutrition Delay Wound Healing
Important Treatments/Considerations for PVD Elderly
Skin care
Diuretics
Compression Stockings
Elevation as often as possible
Assess feet - they will be colder in PVD
Compression stockings to contain edema
Types of Cerebrovascular Disease in the Elderly
Ischemic Stroke
Hemorrhagic Stroke
TIA
Reasons for Ischemic Stroke in the Elderly
Arterial clots
Cardio Embolism
Hematological Disorders
System Hypo Perfusion
*Blood pools and forms clots which lead to stroke
Reasons for Hemorrhagic Stroke in the Elderly
Uncontrolled HTN
Malformations of Blood vessels leading to aneurysm (seen at birth, and may one day burst)
TIA
Transient Ischemic Attack
It is a mild stroke that can occur
S/S of TIA
sudden weakness or numbness on one side
loss of vision or dimness in one eye
slurred speech, loss of speech or inability to comprehend speech
difficulty walking, loss of balance, falling, dizziness
sudden severe headache, confusion
difficulty swallowing
N/V
Risk Factors for Stroke in the Elderly
Heart Disease
Diabetes
HTN
Hypercholesterolemia
Diabetes
Smoking
Brain Tumor
Family History
Coagulopathies
Risk Factors for Diabetes Mellitus
Increasing age
HTN
First degree relative with diabetes
History of impaired glucose tolerance or impaired fasting glucose
Ethnicity (AA more likely)
Previous gestational diabetes or having child greater than 9 lbs
high HDL or triglycerides
Coagulopathy
coagulation factors are not being made/there (like in liver disease)
What levels of HDL or triglycerides are leaving the elderly at higher risk for DM
HDL 35 mg/dL
Triglycerides - 250 mg/dL
S/S of Diabetes mellitus type 2
Periodontal disease
dehydration
confusion
delirium
poor visual acuity
incontinence
weight loss
anorexia
UTI
candida infections (yeast)
wounds that wont heal
fatigue
nausea
paresthesia (trouble feeling)
orthostatic HTN
HgA1C > = 6.5%
What issue can DM Type 2 lead to?
Hypoglycemia
Foot problems
ulcers
PVD
numbness of extremities (neuropathy)
amputations
recurrent non healing infections
may lead to social isolation
Treatments and Care for DM Type 2
Foot care
medications
comfort care (if end stage)
diet (could be difficult)
Risk Factors for Hypothyroidism in the Elderly
Age older than 60
Female
Menopausal
History of infertility or miscarriage
History of smoking
Radiation treatment to head, neck, chest, and tonsil area
S/S of Hypothyroidism
Fatigue
Weakness
Depression and confusion
Slow insidious onset
Why is Hypothyroidism often undiagnosed?
Because it is commonly misdiagnosed as dementia!
Treatments for Hypothyroidism
TSH Measurements
Medications
Common Digestive System changes in the elderly occur in what areas?
Esophagus
Stomach
Esophagus changes in the Elderly
contractions increase
Propulsion is decreased
What occurs due to the changes in the esophagus for the elderly?
Contraction increase leads to more hiccupping
Propulsion decreases lead to GERD
Both can lead to potential aspiration (especially GERD)
Stomach Changes in the Elderly
Decreased motility
GERD r/t decrease in resting pressure of esophageal sphincter
Increased risk for aspiration (d/t GERD) - may precede swallowing issues - so it is important to raise the HOB
Reduced secretion of bicarbonate and gastric mucous
Decreased production of intrinsic factor
Increase weight loss r/t anorexia
Risk factors for Constipation for the Elderly?
Decrease in fluid intake (many older people do not want to drink because of their diuretic use and do not want to keep going to the bathroom)
Immobility
Medications (can slow things down like with pain meds)
Decreased Motility
S/S of Constipation in the Elderly
Confusion
Behavior Changes
Abdominal Discomfort
Loss of Appetite
Nausea
UTI
Urinary retention
What emergency can occur from constipation in the elderly?
Fecal impaction leading to acute intestinal obstruction that could lead to a burst - this is an emergency!
Treatments/Interventions for Constipation in the Elderly?
Medication review (remove what is unneeded)
Increase fluid intake, encourage ambulation
follow bowel protocol
Close monitoring and documentation! (do not just doc, monitor)
Common Respiratory Disorders in the Elderly
COPD:
Bronchitis - inflammatory
Emphysema - oxygen dependent
Air Hunger
Risk Factors for the Respiratory Diseases in the Elderly
Smoking
Alcoholism leading to Ascites
Heart Disease
Institutionalized - closed in / poor air ventilation
Normal physiologic changes
What are some normal respiratory system physiologic changes in the elderly?
Decreased cough reflex
Increased residual volume (air sitting there normally)
Less responsive cilia (harder to get things out)
Musculoskeletal and nervous system changes leading to changes like loss of elastic recoil, stiffening of chest wall - kyphosis/scoliosis, inefficiency in gas exchange
Higher risk for infection d/t less responsive cilia, diminished cough, and fatigue
How does Alcoholism lead to respiratory disease?
It causes ascites, fluid build up around the belt, which makes it hard to expand the lungs since it is pressing against them
Many elderly on oxygen still ___
smoke!
S/S in COPD, Bronchitis & Emphysema
Decreased alertness indicating decreased O2 or increased CO2
Wheezing
Prolonged Expiration
Pursed Lip Breathing
Barrel Chest
Hyper resonance
Pale lips and nail beds
clubbing of fingernails
increased use of accessory muscles
Insidious symptom onset potentially!!!
What are some issues that can occur d/t COPD, Bronchitis and Emphysema in the elderly?
Pneumonia
Respiratory Failure
Tracheotomy
Ventilator Assistance
Treatments and Nursing Intervention for COPD, Bronchitis, and Emphysema Elders
Good/great oral care
maintain functional status and QOL
medication
O2
activity limitations
avoid stress
breathing exercises (lean forward - very much for barrel chest, not so much kyphosis)
education and support
Factors that increase risk for Lung Cancer
Ages greater than 65
Higher in men than women
Higher in smokers than non-smokers
Symptoms of Lung Cancer
Dyspnea
Coughing
Chest Pain
Fatigue
Anorexia (Tumors take a lot of energy leading to weight loss)
Wheezing and Respiratory infections
Treatments for Lung Cancer
Surgery
Chemo and Radiation Therapy
Sometimes it is just comfort care
Kidney changes with age
loss of nephrons
decreased kidney mass volume
Renal Vessel changes with age
decreased renal blood flow
Ureter, Bladder, and Urethra changes with age
Decreased tone and elasticity
decreased bladder holding capacities
urgency and frequency increases
nocturia
How does Glomerular Filtration Rate (GFR) change with age?
Once it begins to decline, it undergoes a linear decline
Female Reproductive System changes with Age
Decreased Estradiol and Estrone
Menopause and Hot Flashes
Vaginal Dryness
Sleep Disturbances
Male Reproductive System changes with Age
BPH (benign Prostatic hypertrophy)
Difficulty urinating - start/stop
May develop kidney stones
BPH
Benign Prostatic Hypertrophy
Enlarged prostate which can cause urination issues leading to kidney stones
What are the important things to do for rehabilitation for expected chronic and normal changes in the elderly?
Maximize QOL
Maintain individuality and autonomy
increase level of independence
increase exercise tolerance
increase self esteem and self care skills
What are the number 1 things to do/keep in mind when caring for an older adult?
MAXIMIZE QOL (and Dignity)
Types of Abuse that occur to the Elderly
3 Types of Abuse:
- Abuse
- Neglect
- Mistreatment
Subcategories: Physical Emotional Sexual Exploitation Neglect Abandonment
Risk factors Increasing the Older Adults risk for Elder Mistreatment
lack of resources or access to resources
low income
social isolation
low level of education
functional debility
cognitive impairment (big one since it can lead to burnout for the caregiver)
dependence on caregiver for ADLs
substance or alcohol abuse
psychological disorders
history of family violence
Risk factors increasing the Caregivers likeliness of committing elder mistreatment
Mental illness
substance or alcohol use/abuse
burnout, frustration, stress, and/or resentment
dependence on the elder for financial or material support
poor relationship with the elder before caregiving
Most Perpetrators of Elder Abuse are?
40% - Adult Children
15% - Spouse
9% Grandchildren
A high percentage is family!
What group is most likely to report cases of elder abuse?
Health Care Providers
They are mandated reporters and need to be vigilant
Physical Signs of Elder Abuse
Injury that hasnt received proper care
Injury inconsistent with explanation for its cause
Pain from touching
cuts, puncture wounds, burns, bruises, welts
Dehydration or malnutrition without illness related cause
poor coloration
excessive drugging, lack of medication
fear
sunken eyes or cheeks
inappropriate administration of medication
soiled clothing or bed (is it abuse or socioeco related)
frequent use of hospital or healthcare/doctor-shopping (caregiver gets extra meds for themselves)
lack of necessities like food, water, or utilities
lack of personal effects, pleasant living environment, personal items
force isolation - abuse
Do physical signs of elder abuse always mean there is abuse?
no, but it is important to investigate carefully
if they fit a category, be suspicious and ask questions
Signs of Sexual Abuse occurring for an elder?
Physical signs (bruises, pain, itching) on the genital area or breasts
Sexually transmitted disease diagnosis
Change in older adult’s behavior or mood that is unexplained
Fear of physical exam of genital area (ex: bed bath, peri care, fear of undressing)
Elder Behavioral Signs of Abuse
Fear
Anxiety or Agitation
Anger
Isolation and Withdrawal
Depression
Non-responsiveness, Resignation, Ambivalence
Contradictory statements, implausible stories
Hesitation to talk openly
Confusion or Disorientation
Suicide Attempts or Thoughts
Signs by the Caregiver of Elder Abuse
Prevents elder from speaking to or seeing visitors
Displays anger, indifference, aggressive behavior toward the elder
History of substance abuse, mental illness, criminal behavior or family violence
Lacks affection toward the elder
Acts flirtatious or coy, a possible indicator of inappropriate sexual relationships
Gives conflicting accounts of incidents
Talks of elder as a burden
Blames the older adult for the mistreatment
Signs of Financial Abuse or Exploitation of an Elder
Frequent expensive gifts from elder to caregiver (to try and get them to stay)
Numerous unpaid bills
Elder personal belongings, papers, credit cards all missing
Recent will when elder seems incapable of writing a will (will manipulation)
Caregivers name added to bank account
elder unawareness of monthly income
Elder signs on another’s loan
Frequent checks made out to “Cash”
Unusual activity in bank account
Irregularities on tax return
Elder unaware of reason for appointment with banker
Refuses to spend money on elder even if its their money
Fraud signatures
What is the healthcare providers responsibility regarding elder abuse?
PARC
Protect
Advocate
Report (Mandated)
Care
*maybe call APS hotline
